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weekly_rounds_july_29_2022_5_things_you_may_have_missedWeekly Rounds: July 29, 2022 - 5 Things You May Have MissedLatest_NewsShared_Content/News/Weekly_Rounds/2022/weekly_rounds_july_29_2022_5_things_you_may_have_missed<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Weekly%20Rounds/Weekly-Rounds-Article-Graphic-2022-645x425px.png" class="pull-right" alt="Weekly Rounds logo" /></div> <h5>July 29, 2022</h5> <h2>5 Things You May Have Missed</h2> <p>Jennifer Hanscom, CEO</p> <p> While for many the news cycle may appear to slow a bit in the summer months, that's rarely the case for physicians and health care. If you've been busy these past weeks, whether in your practice or (hopefully) on a much-needed vacation, here are several quick news updates to keep you abreast of the health care news cycle here in the Evergreen State. </p> <h3>Washington's hospitals and health systems face large financial losses</h3> <p> Last Thursday, the Washington State Hospital Association held a press briefing to announce the results of a statewide financial impact survey of Washington's hospitals. Hospitals representing 97% of all inpatient beds in Washington state responded to survey, which compared hospitals' financial performance of the first quarter of 2022 to the first quarter of 2021. The survey results paint a dire picture, with hospital operating revenues up 5%, operating expenses up 11% (driven by increased workforce, supply, and drug expenses), and total operating losses combined with investment losses resulting in a net loss of $929 million (a 13% net loss). All 52 urban hospitals and health systems reported negative margins, and account for 99% of losses statewide. Of the independent rural hospitals, 18 out of 34 reported negative margins. Reasons cited for these large losses include low Medicaid reimbursement, high inflation and labor shortages, employee compensation increases, temporary labor spending increases, more complex patients with costs of care higher than rates of reimbursement, especially patients on Medicaid and Medicare, and expenses related to the large and increasing number of patients ready for discharge unable to be transferred. </p> <p> In response to this financial shortfall, WSHA is asking the state to act to get difficult-to-discharge patients into appropriate settings to allow hospitals to focus on critical care, and it will seek long-term solutions from the Legislature in 2023, including an increase in Medicaid rates for hospitals, funding for new facilities for patients needing long-term care, and funding to address the behavioral health crisis, including more staffing, facilities, and upstream interventions. </p> <h3>WSMA seeking input for 2023 legislative agenda</h3> <p> Speaking of Medicaid rates, the WSMA will be pursuing raising Medicaid rates to Medicare levels for all physician services in 2023 (to include services performed by PAs and ARNPs). This is just one of the priorities topping our preliminary 2023 legislative agenda. Our team has surveyed WSMA's membership and leadership on the most pressing issues facing their practices and we will be using those results to outline what we plan to pursue in the 2023 session. You can get a preview of what issues are rising to the top of our agenda at our next Advocacy Council meeting on Aug. 16 at noon via Zoom. During the session, our government affairs team will also provide insights on the fall midterm elections and how they may affect our agenda in 2023. <a href="">Register for the WSMA Advocacy Council meeting online</a>. </p> <h3>Registration is now open for the WSMA Annual Meeting</h3> <p> The WSMA is set to have our Annual Meeting Oct. 1 and 2 at the Davenport Hotel in Spokane. In preparing for the policy debate that takes place at the House of Delegates, our staff is collecting resolutions to set our policy or direct our action. If you have an idea you'd like to get before the House of Delegates, a resolution template and other frequently asked questions can be found <a href="[@]WSMA/Events/Annual_Meeting/How_to_Write_a_Resolution/WSMA/Events/Annual_Meeting/How_to_Write_a_Resolution/How_to_Write_a_Resolution.aspx?hkey=a22cd977-aaed-4445-9ee2-6fc4716a7136&_zs=B3aFd1&_zl=mhKU8">on the WSMA website</a>. To have your resolution included in the delegate handbook (a compilation of resolutions and other business to be considered by delegates at the Annual Meeting) you must submit it to <a href=""></a> by Aug. 12. All resolutions must be sponsored by two WSMA delegates. If you need help identifying sponsors or have additional questions on the House of Delegates or resolution drafting, email the WSMA Policy Department at <a href=""></a>. </p> <p> As soon as resolutions are finalized with a fiscal note and health equity note, they will be posted in our password-protected Virtual Reference Committees, where all members can share their thoughts and opinions. <a href="[@]WSMA/Membership/Discussion_Forums/Virtual_Reference_Committees/WSMA/Membership/Discussion_Forums/virtual_reference_committees.aspx?hkey=d674a5ae-4fb5-48d6-b969-16aab9b63647&_zs=B3aFd1&_zl=ohKU8">Bookmark the page to join the conversation</a>. </p> <h3>WSMA provides input on apprenticeship rulemaking to L&I</h3> <p> The Department of Labor and Industries has initiated <a href="" target="_blank" rel="noreferrer">rulemaking</a> on apprenticeships as a result of <a href="">Senate Bill 5600</a>, which passed the Legislature in 2022 with the intent of sustaining and expanding the state's registered apprenticeship programs. The WSMA supported this legislation during session and will provide the same support throughout the rulemaking process. The WSMA submitted a <a href="" target="_blank" rel="noreferrer">comment letter</a> on June 24 requesting that L&I consider an apprenticeship platform for medical assistants under the health care and behavioral health platform. Providing medical assistants an apprenticeship pathway will strengthen care teams, improve the quality of care patients receive, and help mitigate workforce issues facing our state. This rulemaking is still in the 101 phase, or Preproposal Statement of Inquiry. The WSMA will be sure to keep you apprised of updates as this rulemaking progresses. </p> <h3>Payers must post negotiated prices</h3> <p> The Centers for Medicare and Medicaid Services' <a href="">Transparency in Coverage final rule</a> took effect on July 1, requiring payers nationwide to publish the cost of nearly every health care service they've negotiated with physicians and health care professionals. The rule requires payers to disclose in-network physician and health care professional rates for covered items and services; out-of-network allowed amounts and billed charges for all covered items and services; and negotiated rates and historical net prices for covered prescription drugs administered by physicians and health care professionals. Payers not in compliance could face fines of up to $100 per day for each violation and for each individual affected by the violation. The rule provides accommodations for health plans using alternative reimbursement arrangements that cannot accurately provide a specific dollar amount until after services are rendered. If you have any questions about CMS' new rule you may contact our policy department at <a href=""></a>. </p> <p> As always, thank you for all you do in caring for Washingtonians, and keeping our state healthy. </p> </div>7/29/2022 12:00:00 AM1/1/0001 12:00:00 AM
aetna_rescinds_prior_authorization_requirement_on_cataract_surgeriesAetna Rescinds Prior Authorization Requirement on Cataract SurgeriesLatest_NewsShared_Content/News/Membership_Memo/2022/July_22/aetna_rescinds_prior_authorization_requirement_on_cataract_surgeries<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/july/surgeon-645x425px.jpg" class="pull-right" alt="closeup photo of surgeon with headgear" /></div> <h5>July 22, 2022</h5> <h2>Aetna Rescinds Prior Authorization Requirement on Cataract Surgeries</h2> <p>Aetna recently <a href="" target="_blank" rel="noreferrer">announced</a> that as of July 1, it will no longer require prior authorization for cataract surgery, with the exception of Florida and Georgia Medicare Advantage patients. This change follows advocacy by the American Academy of Ophthalmology, the American Society of Cataract and Refractive Surgery, and other members of the federation of medicine that highlighted the care delays, practice administrative burdens, and patient and public safety concerns associated with this policy. For an update on other prior authorization reform efforts, including federal legislation that would streamline prior authorization in Medicare Advantage plans, see this <a href="[@]Shared_Content/News/Weekly_Rounds/2022/weekly_rounds_april_29_2022_prior_authorization_plagues_us_all">recent Weekly Rounds issue</a> from WSMA CEO Jennifer Hanscom.</p> <p>The WSMA has worked hard to address prior authorization challenges in Washington state. You may recall that <a href="">new rules</a> went into effect in 2018 that were intended to ease the administrative burden you face as you strive to meet the requirements of state-regulated insurers or their third-party administrators when seeking prior authorization of medical services. To help practices adjust workflows to accommodate the new requirements, the WSMA introduced the <a href="">Prior Authorization Navigator</a> - a mobile-friendly "one-stop-shop" website for guidance on the new rules. There you'll find a <a href="">one-minute bullet-point summary</a> of the new rules as well as in-depth guidance on the rules' provisions. You'll also find guidance on 2015 rules covering <a href="">prior authorization of prescription drugs</a>.</p> <p>If you encounter an insurer or third-party administrator out of compliance with Office of the Insurance Commissioner's prior authorization requirements, you can easily file a complaint by utilizing the WSMA's Prior Authorization Navigator's <a href="">complaint form</a>. We urge you to take advantage of this tool.</p> </div>7/22/2022 12:00:00 AM1/1/0001 12:00:00 AM
medicare_proposes_2023_payment_and_quality_reporting_changesMedicare Proposes 2023 Payment and Quality Reporting ChangesLatest_NewsShared_Content/News/Membership_Memo/2022/July_22/medicare_proposes_2023_payment_and_quality_reporting_changes<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/june/medicare-barcode-645px.jpg" class="pull-right" alt="Medicare barcode" /></div> <h5>July 22, 2022</h5> <h2>Medicare Proposes 2023 Payment and Quality Reporting Changes</h2> <p>The Centers for Medicare and Medicaid Services recently <a href="">released</a> its proposed 2023 Medicare physician fee schedule rule, which includes proposed changes to the Merit-based Incentive Payment System and alternative payment model participation options and requirements for 2023.</p> <p>Key proposals include:</p> <ul> <li>Setting 2023 Medicare payment rates for physician services. For 2023, CMS proposes a conversion factor of $33.0775 and $20.7191 for anesthesia (a decrease of -4.42% and -3.91%, respectively, over final 2022 rates).</li> <li>Permitting certain telehealth services to remain on the Medicare Telehealth Service list for 151 days after the expiration of the COVID-19 public health emergency, such as telephone E/M codes (99441 - 99443).</li> <li>Extending flexibilities to permit split/shared E/M visits to be billed based on one of three components (history, exam, or medical decision making) or time until 2024.</li> <li>Expanding access to behavioral health by permitting marriage and family therapists, licensed professional counselors, addiction counselors, and others to furnish behavioral health services under general supervision instead of direct.</li> <li>Maintaining the MIPS performance threshold at 75 points for the 2023 MIPS performance year/2025 payment year.</li> <li>Adding five new MIPS Value Pathways related to nephrology, oncology, neurological conditions, and promoting wellness for voluntary reporting beginning in 2023.</li> <li>Creating an advanced incentive payment pathway for certain low-revenue, new entrant accountable care organizations to bolster participation in the Medicare Shared Savings Program.</li> </ul> <p>The WSMA remains <a href="[@]Shared_Content/News/Membership_Memo/2022/June_24/full_medicare_sequester_will_be_applied_on_july_1.aspx?_zs=A3aFd1&_zl=tWxQ8">committed to the sustainability</a> of the <a href="[@]Shared_Content/News/Membership_Memo/2022/June_24/wsma_endorses_ama_medicare_physician_payment_reform_principles.aspx?_zs=A3aFd1&_zl=xWxQ8">Medicare program for physicians and patients</a>. While we are still analyzing the proposal, we are deeply concerned about the across-the-board payment reductions and will continue to work with the American Medical Association and Congress to prevent them.</p> <p>Review the <a href="">proposed rule</a>, the <a href="">2023 Medicare physician fee schedule fact sheet,</a> and the <a href="">2023 Quality Payment Program fact sheet</a> (zip file). The final rule is expected by Nov. 1, 2022.</p> <p><em>Update courtesy of the Medical Group Management Association.</em></p> </div>7/22/2022 12:00:00 AM1/1/0001 12:00:00 AM
making_the_post_pandemic_transitionMaking the Post-Pandemic TransitionLatest_NewsShared_Content/News/Latest_News/2022/making_the_post_pandemic_transition<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/july-aug-2022-reports-article-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports July/August 2022" /></div> <h5>July 12, 2022</h5> <h2>Making the Post-Pandemic Transition</h2> <h5> <em>Members only; sign-in required.</em> </h5> <p> By Rita Colorito </p> <p> On May 17, the U.S. Department of Health and Human Services signaled it would extend the federal COVID-19 public health emergency declaration set to expire in mid-July for another 90 days, until mid-October. First implemented in January 2020, the declaration allowed for much-needed health care flexibilities to mitigate the spread of the novel coronavirus and care for those sickened while maintaining virtual access to routine health services. This included reducing telehealth regulations, expanding Medicaid enrollment, expediting licensing processes, and providing access to COVID-19 vaccines, tests, and treatment with no cost to individuals, regardless of insurance status. </p> <p> The medical community, bracing itself to lose these flexibilities, breathed a collective sigh of relief at the new timeline. But there are mounting pressures on the Biden administration to end the public health emergency, despite ongoing surges and other pandemic pressures. Unfortunately, the reprieve may be short-lived, potentially to the detriment of patient care. </p> <h3> What's at stake?</h3> <p> "Both state and federal waivers have resulted in diminishing several administrative burdens during a time of crisis. However, we are not out of the woods yet," says Jennifer Hanscom, CEO of the WSMA. "We need to, at the very least, continue these flexibilities until we are sure we have a handle on COVID and have addressed all pent-up demand still in our communities." </p> <p> For now, HHS has agreed to provide states with 60-days' notice prior to terminating the COVID-19 public health emergency. The WSMA and other parts of organized medicine are carefully tracking the public health emergency and its implications for practices. </p> <p> "We want to make sure federal and state governments unwind these flexibilities in a way that is predictable and manageable, while also considering keeping those policies that have led to improvements in health care delivery and access," says Jeb Shepard, director of policy for the WSMA. </p> <p> Hanscom agrees. "Ideally, we need to garner support to make permanent some of the most beneficial waivers. This will require new laws and regulations passed at both the state and federal level." </p> <p> Wholesale ending of funding and regulatory flexibilities would put additional strain on health care systems already struggling to play catch-up with a stretched and stressed workforce, says Mika Sinanan, MD, PhD, WSMA president. "We're in a new phase of the COVID experience where patients who delayed or deferred care are now filling our hospitals. And there are huge staffing and inflation issues. As those benefits go away, it only adds to this very difficult transition period." </p> <p> The post-pandemic transition has begun, as many state and local governments have already rescinded their emergency orders. Of the 89 COVID-19-related proclamations Gov. Jay Inslee signed, only 29 remain in effect in whole or in part, including the requirement that those working in health care settings be vaccinated unless they have a religious exemption or precluding disability. The health care vaccine mandate is a measure the WSMA continues to support, says Dr. Sinanan. "Our leadership position has always been that this is a safety issue," he says. </p> <h3>Impacts on telehealth </h3> <p> The expansion of telehealth services removed one of the pandemic's biggest health care hurdles-access to care-especially during public lockdowns when office visits and elective procedures were discouraged or prohibited. It's a pandemic flexibility the WSMA and its members would like to become permanent. </p> <p> Under the public health emergency, physicians seeing Medicare patients don't need to establish an in-office patient relationship before providing services via telehealth. Waivers allow for some audio-only care and the use of certain social media platforms to see patients, which previously violated HIPAA privacy rules. The Centers for Medicaid and Medicare Services also began covering 100 new telemedicine services at in-person reimbursement rates. Waivers also allowed for the extension of medical care across state lines to support outpatients who livedor were located in other states. </p> <p> "It was really a message of just step up and take care of patients. That was an enormous relief during such a highstress time," says Marcia Sparling, MD, chief medical information officer and medical director for surgical specialties at Vancouver Clinic. </p> <p> Dr. Sparling's concern is that once the health emergency ends, CMS will tighten how it reimburses for telehealth visits and prohibit telehealth visits across state lines. "I would hope that Medicare modernizes aggressively and accepts that this is the way the world works now," she says. "For example, we have patients who might live in Vancouver, but they do a video visit across the river in Portland [Oregon], because that's where they work. And this occurs all over the country where people move back and forth across state boundaries." </p> <p> For mental health practitioners, relaxed telehealth rules and payment parity have been particularly critical to patient care, says Donna Lohmann, MD, a private-practice psychiatrist in Seattle. "I didn't have to skip a beat. My practice pivoted and it pivoted quickly," she says. </p> <p> While Dr. Lohmann didn't take on new patients during the pandemic, two former patients whom she hadn't seen in a few years returned. Because of relaxed telehealth rules, she could schedule telehealth visits without needing to see them in her office first. </p> <p> Most of the time, Dr. Lohmann's telehealth portal worked well for her tech-savvy patients. But glitches can and did sometimes happen, so they used FaceTime as a backup. Losing that option, says Dr. Lohmann, could make it more difficult to care for patients. "It's a real issue because technology is certainly never 100%," she says. </p> <p> For continuity of care, Dr. Lohmann, Dr. Sparling, and others would like to see federal licensing across state lines. "Right now, if somebody leaves the state for a few weeks and they have a crisis, I'm not allowed to treat them. It's not particularly pandemic-related but it became a much bigger issue during the pandemic. You have to choose between breaking the law and abandoning a patient. And that's not a choice anyone should have to make," says Dr. Lohmann. </p> <p> Medical licensure still rests with the states, and federal involvement in licensure remains a thorny issue. But the WSMA has recently made progress, working with both Oregon and Alaska to update their telemedicine policies to permit Washington-licensed physicians and physician assistants to provide followup care to established patients without obtaining licensure in those states. The WSMA is working with other states to update policies, including Wyoming, Montana, and Idaho, says Shepard. </p> <h3>The impact on Medicaid</h3> <p> As businesses closed shop and Americans lost their jobs, many found themselves without health insurance or unable to pay. The public health emergency allowed for continuous Medicaid enrollment, suspending the need for yearly Medicaid redetermination. Nationwide, continuous enrollment contributed to a Medicaid enrollment growth of 20.5% between February 2020 and November 2021. </p> <p> When the health emergency ends, millions of people could lose Medicaid coverage or potentially face higher costs for insurance coverage. The WSMA supports continued federal funding increases for Medicaid and congressional reauthorization of funds to support the uninsured. </p> <p> In Washington state, about 361,400 people have joined Apple Health, the state's Medicaid program, since the start of the pandemic, according to the Washington State Health Care Authority. Once the public health emergency ends, enrollees will need to verify their Medicaid eligibility once they hit the month their one-year anniversary would have normally occurred. It's unknown how many enrollees will still be eligible for Apple Health once the health emergency ends. </p> <p> The redetermination process will take place over 12 months, says Charissa Fotinos, MD, the HCA's state Medicaid director and behavioral health medical director. "We will need to reach out to all those folks by whatever means we can and check to see if they're still eligible for Medicaid. If they are, we re-enroll them. If they are not, we will refer them to the health insurance exchange so they may look at other insurance products. There are some plans with subsidies for income levels that exceed Medicaid but aren't high enough to warrant people managing insurance on their own." </p> <p> Physicians, physician assistants, and nonphysician providers can play a vital role in making sure these vulnerable patients continue to receive the services they need, says Dr. Fotinos. While they won't directly be involved in determining Medicaid eligibility, she asks physicians and PAs to encourage their patients to read any notices they receive from the HCA or CMS. "Physicians can be good partners with us," says Dr. Fotinos. "And if they have questions, they can certainly reach out to us." </p> <p> In April, the HCA released an external guide on what happens to Apple Health eligibility during and after the expiration of the COVID-19 public health emergency, which physicians and health care systems can download from its website. </p> <h3>Impacts on COVID-19 testing, treatment, and vaccine coverage</h3> <p> To fight the pandemic, the U.S. Food and Drug Administration issued emergency use authorizations for three vaccines and hundreds of COVID-19 tests and treatments. According to the FDA, an emergency use authorization declaration is distinct from, and is not dependent on, the federal public health emergency declaration related to COVID-19. An emergency use authorization may remain in effect beyond the duration of the health emergency if other statutory conditions are met. </p> <p> While some vaccines and therapeutics have received full FDA approval, the concern is that ending the public health emergency may trigger the FDA to terminate emergency use authorization for products that haven't obtained full approval. There's also concern over federal funding for vaccination, testing, and treatment. </p> <p> "We know that timely access to vaccines and boosters as well as timely access to antiviral medications like Paxlovid and to monoclonal antibodies given to people at high risk of hospitalization or death reduces the risk of severe disease. So, we really need to remove any barriers that we can to vaccination, testing, and treatment. Our hope is that federal funding and support continue to be really strong," says Tao Sheng Kwan-Gett, MD, chief science officer for the Washington State Department of Health. </p> <p> It's hard to predict what impact ending the health emergency will have on funding. "It's not an automatic given that funding for testing, treatment, or vaccination would be reduced. But it's certainly a possibility," says Dr. Kwan-Gett. </p> <p> Through the FEMA Stafford Act, the federal government has reimbursed physicians and health care systems 100% for COVID-19 testing. While there is no set date to end Stafford Act funding, as of July 1, the cost-sharing formula will shift, with the federal government now covering 90% and state and local agencies each paying 5%, signaling the first change in funding, says Dr. Kwan-Gett. </p> <p> "The funding change won't affect what physicians and health care providers do. It just means the Department of Health will make up 10% of the cost," he says. "Ending the public health emergency certainly wouldn't change anything about the vitally important role of physicians in vaccinating people and in testing them and getting them access to treatment for those at high risk." </p> <p> For now, Washington state has several funding mechanisms that support the COVID-19 response, says Dr. Kwan-Gett. The state's COVID programmatic grant awards-like Epidemiology and Laboratory Capacity for Prevention and Control of Emerging Infectious Diseases and vaccine dollars-are not impacted by the end of federal reimbursement for coronavirus vaccine administration, testing, or treatment. These grants have already been awarded, and the funding continues with expiration dates ranging from July 2023 to June 2024. </p> <p> In May, the WSMA surveyed its members to better understand which flexibilities physician practices are relying on, what factors should be considered in deciding to end or retain them, and what preparation is needed at the practice level to end a waiver. As the next public health emergency end date looms, the WSMA hopes members will add their voices to the need to keep pandemic-era flexibilities in place, says Dr. Sinanan. "Their stories of how the benefits of the public health emergency impacted their practices will go a long way toward advocacy and moving health care forward." </p> <p> <em>Rita Colorito is a freelance writer specializing in health care.</em> </p> <p> <em>This article was featured in the July/August 2022 issue of WSMA Reports, WSMA's print magazine.</em> </p> </div>7/12/2022 12:00:00 AM1/1/0001 12:00:00 AM
the_fix_that_wasntThe Fix That Wasn'tLatest_NewsShared_Content/News/Latest_News/2022/the_fix_that_wasnt<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/Reports/2022/july-aug-2022-reports-article-645x425px.jpg" class="pull-right" alt="cover illustration for WSMA Reports July/August 2022" /></div> <h5>July 12, 2022</h5> <h2>The Fix That Wasn't</h2> <h5> <em>Members only; sign-in required.</em> </h5> <p> By John Gallagher </p> <p> When Congress overhauled the Medicare payment system for physicians in 2015, the reforms put an end to a model that was plainly broken. At the time, physicians were facing a 21% cut in Medicare fees, the latest in an endless line of "cliffs" created by a formula designed to tie spending to overall economic growth. The new system held the promise of removing the perennial threat of impending fee cuts while also creating payment models that rewarded high-value care. </p> <p> "It became so overwhelming that Congress finally had enough," says Jason Marino, director of congressional affairs at the American Medical Association. "We were happy at the time" with the new system and the incentives for valuebased care. </p> <p> As it turns out, that optimism was short-lived. Just seven years after that overhaul, the Medicare payment system is again stuck in a cycle of statutory payment cuts that require Herculean effort to avoid every year. At the same time, the alternative payment models originally envisioned as encouraging greater innovation and value in care have proven harder to implement due to inadequate incentives and unrealistic requirements. </p> <h3>A need for change </h3> <p> "We're still in the same situation where every year we have to fight back the cuts we don't want to have happen," says Jennifer Hanscom, CEO of the WSMA. "It's frustrating to be on that hamster wheel." </p> <p> The need for change is evident. Physicians are facing a continuing statutory freeze in annual Medicare physician payments that is scheduled to last until 2026. After that, payment updates will resume, but only at a rate of 0.25% a year indefinitely. </p> <p> Medicare physician payment has fallen 20%, adjusted for inflation, since 2001. At the same time, the cost of running a medical practice increased 39% since 2001. In the meantime, Medicare payment updates to physicians have been far outpaced by increases for others. While Medicare physician pay rose 11% since 2001, payment updates increased roughly 60% for inpatient and outpatient hospital services and for skilled nursing facility services. </p> <p> Compounding the problem of low and eroding reimbursement is the fact that insurers increasingly use Medicare as their baseline for payment standards. "The rates for much of commercial insurance, which in the past had cross-subsidized Medicare and Medicaid, are trending toward Medicare," notes Mika Sinanan, MD, PhD, a surgeon at the University of Washington and current president of WSMA. "They say you have to live and work at a Medicare level." </p> <p> It's no surprise that as a result of this combination of factors, the Medicare payment system is exacting a high toll on practices and on patient care across the state and the country. </p> <p> "The impact on practices is uncertainty about the sustainability of taking Medicare patients," Dr. Sinanan says. "It's impacting the sustainability of physicians to offer services to Medicare patients. There's going to be an access problem in parts of the country and parts of the state." </p> <p> Easy in theory, difficult in practice An improved payment system was one fix promised seven years ago. The other was a pathway toward rewarding valuebased care models. It too has proven to fall far short of expectations. </p> <p> The congressional legislation created several new alternatives to traditional fee-for-service payment. The Medicare Merit-Based Incentive Payment System based payments on the Medicare Part B physician fee schedule, but those payments can be adjusted either up or down depending on scores from four performance categories. The scoring is complex and the administrative burden for participating in MIPS is onerous. A 2021 study published in JAMA Health Forum found that it costs an estimated $12,811 and takes more than 200 hours per physician annually to comply. </p> <p> Medicare's attempt to encourage practices to embrace advanced alternative payment models has proven equally complicated. Practices can earn a 5% bonus, but setting up such an innovative model is something only the largest practices are able to consider. </p> <p> "Medicare wants to pay physician practices based on the risk scores of their patients. However, in small private practices, there are no additional resources to help physicians be successful in capturing the true risk scores," says Katina Rue, DO, Trios Health Family Medicine Residency Program Director and president-elect of WSMA. "I question how practices doing that can accurately capture this information. </p> <p> It's often on the backs or fingertips of the physicians without organizational resources or support such as coders." </p> <p> The bottom line is that a practice will need to hire staff, which, as Dr. Rue says, "do pay for themselves eventually, but there is an 18-month turnaround for reimbursement." The model can drive small practices toward consolidation, which isn't always good for physicians, patients, or their communities, she says. </p> <p> Measuring value has also been a challenge, especially for specialty practices. "The value-based concept makes sense theoretically but has proven to be very difficult to implement, in large part because the goal is to reward outcomes, but there's no easy mechanism to track outcomes and measure them objectively," says Dr. Sinanan. Instead, surgeons find themselves dealing with unrelated process measures, such as blood pressure control for patients with diabetes. </p> <p> Amid this confusion, the rules are changing regarding the alternative payment models. The 5% bonus is slated to go away at the end of this year, and practices will need to increase the number of participating patients from 50% of their practice to 75%. That will essentially set those practices that willingly embraced innovation on a path to failure. </p> <p> "I believe that even most big systems will not qualify" under the new requirements, says Marino. "All the other investments in APMs will just go belly up." </p> <h3>Not if, but when </h3> <p> Given the myriad problems facing Medicare, the need for a major overhaul seems obvious. However, an election year isn't the right time for such an attempt. Instead, organized medicine is laying the groundwork for a twopronged approach: Address some of the most immediate problems in the short term and build the foundation for a bigger fix in the not-too-distant future. </p> <p> "Where we want to focus at this point in time is on those short-term fixes," says Hanscom. </p> <p> Foremost among those fixes is stopping any proposed payment cuts. Indeed, one of the issues that the AMA would like to see addressed is having payments adjusted for inflation, a particularly timely issue right now. "That would go a long way, right there," says Marino. </p> <p> Extending the 5% bonus for APMs is another priority, as is keeping the current patient standard for participation at 50%. Extending a $500 million pool for exceptional performance in MIPS is also important. </p> <p> Longer term, the time is approaching to revisit the entire payment model. </p> <p> "In the end, the goal is to have a strong Medicare program that physicians want to participate in," says Hanscom. "We need to create a rational Medicare payment system that encourages fiscal responsibility and embraces innovation. We've been straddling the canoe and the dock for years. If we're ever going to get into the value-based care boat, we need a program like Medicare to set the parameters for it." </p> <p> <em>John Gallagher is a freelance writer specializing in health care.</em> </p> <p> <em>This article was featured in the July/August 2022 issue of WSMA Reports, WSMA's print magazine.</em> </p> </div>7/12/2022 12:00:00 AM1/1/0001 12:00:00 AM
please_stop_saying_providerPlease Stop Saying 'Provider'!Latest_NewsShared_Content/News/Latest_News/2022/please_stop_saying_provider<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"> <img alt="Susan Baumgaertel,MD" src="/images/newsletters/Reports/2022/july-august/heartbeat-website-image-645x425px.png" class="pull-right" width="645" height="425" /> </div> <h5>July 11, 2022</h5> <h2>Please Stop Saying 'Provider'!</h2> <p>By Susan J. Baumgaertel, MD, FACP</p> <p> When I presented Resolution B-8 at the WSMA House of Delegates 2021 annual meeting, it was with a sense of urgency that patients and the general public deserve to know who is caring for them. Not so easily done, unfortunately. </p> <p> When I started my internal medicine practice in 1996, the medical arena was vastly different than it is today. Back then, having an MD after my name actually meant something. A letter from me to an insurance company would get a needed medication covered for a patient-a time before preauthorization existed. Dr. Google was not yet born. "Provider" exclusively belonged to the insurance industry. </p> <p> My patients called me doctor and referred to me as their physician. Well, most of them. I still chuckle fondly when I recall the World War II vets at the Veteran's Affairs Hospital calling me nurse, no matter how I introduced myself. That's okay-I knew who I was and didn't need to prove it. I actually think they did too and just wanted to get my goat! </p> <!-- <div class="col-sm-5 pull-left" style="text-align: center;"> <img alt="Baumgaertel pullout quote" src="/images/newsletters/Reports/2022/july-august/baumgaertel-pullout-quote.png" class="pull-left" width="569" height="312" /> </div> --> <p> Fast forward to modern times: Professional appropriation runs rampant. I cringe, along with many of my physician colleagues, when I am wished "Happy Providers' Day" instead of "Happy Doctors' Day." And I was stunned when someone recently addressed me as "Provider Susan" in an email-that was a new one. The word "provider" has become ubiquitous. </p> <p> Would you want your pilot to be the same as your flight attendant? "Good morning, I'm airline worker Carl and I'll be flying your plane today." Would you want your trial attorney to say, "I'm Sarah, your legal worker, and will be defending you today"? I am a physician, yet somehow it has become OK to refer to me as anything but physician. </p> <p> In an era where burnout is akin to another pandemic, it is further demeaning and demoralizing to all in medicine to be lumped together as if we are the same. This is just not sustainable. This is also not about ego. It is about patient safety and transparency. Substitute words only serve to confuse the public and take away transparency by implying all training and experience is equivalent, which is simply untrue. </p> <p> I haven't worn a white coat in decades. Nowadays, a white coat means nothing-the beauty counter makeover folks wear them. Everyone wears scrubs. ID badges are now issued with "medical staff" instead of actual titles. Badges also are notorious for flipping over and not actually being visible to patients. All too frequently patients get seen by a "provider" never actually knowing their credentials. </p> <!-- <div class="col-sm-5 pull-right newsbody" style="text-align: center;"> <img alt="parrot" src="/images/newsletters/Reports/2022/july-august/parrot.png" class="pull-right" width="480" height="262" /> </div> --> <div class="col-sm-5 pull-right" style="text-align: center;"> <blockquote style="text-align: left;"><strong> <em> Would you want your pilot to be the same as your flight attendant? "Good morning, I'm airline worker Carl and I'll be flying your plane today." Would you want your trial attorney to say, "I'm Sarah, your legal worker, and will be defending you today"? I am a physician, yet somehow it has become OK to refer to me as anything but physician.</em></strong> </blockquote> </div> <p> How can we fix this? Patients and the public should be completely comfortable with asking who is taking care of them and what are their credentials. Staff need to be trained not to ask, "Which provider are you calling for?" We need to refrain from grouping all physicians, nonphysicians, and health care professionals together using one word. Words matter-at meetings, in emails, on nursing home forms, in the news, on websites, and so on. </p> <p> Let's bring back respect for physicians and respect for nonphysicians. Respect our differences in training and medical experience. We are not all the same. Use our titles individually. With this will come transparency to patients and the public. And with transparency will come improved safety. </p> <p> Washington state has the opportunity to set a decades-overdue example for the rest of the country, not just by making another strong recommendation, but by publicly educating everyone that use of the term "provider" or any other replacement term is unacceptable. </p> <p>Let's reshape modern medicine. It is time.</p> <p> <em>Susan J. Baumgaertel, MD, FACP, is the founder of <a href=""></a> and is a physician advocate, guide, partner, coach, resource, navigator, and educator. She is the author of Resolution B-8, sponsored by the King County Medical Society and adopted by the WSMA House of Delegates in 2021, which called for the WSMA to support education to highlight concerns related to inappropriately using one title to group all medical professionals together (e.g., "provider").</em> </p> <p> <em> Are you passionate about this or another topic? Send us your story (less than 500 words) at <a href=""></a>.</em> </p> <p><em>This article was featured in the July/August 2022 issue of WSMA Reports, WSMA's print magazine.</em></p> </div>7/11/2022 12:00:00 AM1/1/0001 12:00:00 AM
covid_19_vaccines_how_to_embed_them_into_routine_preventive_careCOVID-19 Vaccines: How to Embed Them Into Routine Preventive CareLatest_NewsShared_Content/News/Membership_Memo/2022/July_8/covid_19_vaccines_how_to_embed_them_into_routine_preventive_care<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/july/covid-vaccines-doh-webinars-645x425px.png" class="pull-right" alt="COVID-19 Vaccines Webinar Series graphic" /></div> <h5>July 8, 2022</h5> <h2>COVID-19 Vaccines: How to Embed Them Into Routine Preventive Care</h2> <p>The WSMA has joined the Washington State Department of Health to host a new two-part CME webinar series to help physician practices and clinics access the tools and information they need to incorporate the COVID-19 vaccines into their practice workflows. This first session held on July 29 will cover the logistics of delivering COVID-19 vaccines in a practice or clinic setting.</p> <p>Join us for this free session where you'll learn how to:</p> <ul> <li>Bill for COVID-19 vaccine counseling and administration.</li> <li>Access small, more manageable quantities of COVID-19 vaccines from vaccine depots across the state.</li> <li>Join the more than 65,000 Washington physicians, PAs, and health care professionals who have already committed to educating and empowering their patients to vaccinate.</li> </ul> <p>Leverage the DOH's physician toolkit and public-facing resources to help protect the health and well-being of your community. This activity has been approved for <em>AMA PRA Category 1 Credit</em>â„¢. <a href="">Register for the free session online</a>. And save the date for part two of the series, COVID-19 Vaccines: Strategies to Discuss the COVID-19 Vaccine with Your Most Reluctant Patients, on Friday, Aug. 26, from noon-1 p.m. (only one registration is required to attend both webinars).</p> </div>7/7/2022 12:00:00 AM1/1/0001 12:00:00 AM
hhs_issues_guidance_to_protect_patient_privacy_in_wake_of_supreme_court_decision_on_roeHHS Issues Guidance to Protect Patient Privacy in Wake of Supreme Court Decision on RoeLatest_NewsShared_Content/News/Membership_Memo/2022/July_8/hhs_issues_guidance_to_protect_patient_privacy_in_wake_of_supreme_court_decision_on_roe<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/july/smartphone-hands-645x425px.jpg" class="pull-right" alt="Woman holding smartphone" /></div> <h5>July 8, 2022</h5> <!-- **************************NEW ARTICLE****************************** --> <h2>HHS Issues Guidance to Protect Patient Privacy in Wake of Supreme Court Decision on Roe</h2> <p>The U.S. Department of Health and Human Services' Office for Civil Rights has issued new guidance to help protect patients seeking reproductive health care, as well as their physicians.</p> <p>In general, the guidance does two things:</p> <ol> <li>Addresses how federal law and regulations protect individuals' private medical information relating to abortion and other sexual and reproductive health care, making it clear that physicians are not required to disclose private medical information to third parties; and</li> <li>Addresses the extent to which private medical information is protected on personal cell phones and tablets and provides tips for protecting individuals' privacy when using period trackers and other health information apps.</li> </ol> <p>The guidance addresses the circumstances under which the Health Insurance Portability and Accountability Act Privacy Rule permits disclosure of protected health information without an individual's authorization. It explains that disclosures for purposes not related to health care, such as disclosures to law enforcement officials, are permitted only in narrow circumstances tailored to protect the individual's privacy and support their access to health care, including abortion care. Specifically, the guidance:</p> <ul> <li>Reminds HIPAA-covered entities and business associates that they can use and disclose PHI, without an individual's signed authorization, only as expressly permitted or required by the Privacy Rule.</li> <li>Explains the Privacy Rule's restrictions on disclosures of PHI when required by law, for law enforcement purposes, and to avert a serious threat to health or safety.</li> </ul> <p>The Office for Civil Rights is also issuing information for individuals about protecting the privacy and security of their health information when using their personal cell phone or tablet. This guidance explains that, in most cases, the HIPAA Privacy, Security, and Breach Notification Rules do not protect the privacy or security of individuals' health information when they access or store the information on personal cell phones or tablets. This guidance also provides tips about steps an individual can take to decrease how their cell phone or tablet collects and shares their health and other personal information without the individual's knowledge. This guidance:</p> <ul> <li>Explains how to turn off the location services on Apple and Android devices.</li> <li>Identifies best practices for selecting apps, browsers, and search engines that are recognized as supporting increased privacy and security.</li> </ul> <h3>For reference</h3> <ul> <li><a href="">Guidance on the HIPAA Privacy Rule and Disclosures of Information Relating to Reproductive Health Care</a></li> <li><a href="">Guidance on Protecting the Privacy and Security of Your Health Information When Using Your Personal Cell Phone or Tablet</a>.</li> </ul> <p>If you believe that a HIPAA-covered entity or its business associate violated your (or someone else's) health information privacy rights or committed another violation of the Privacy, Security, or Breach Notification Rules, you may <a href="">file a complaint</a>.</p> </div>7/7/2022 12:00:00 AM1/1/0001 12:00:00 AM
physician_feedback_needed_on_renewed_naturopath_scope_effortPhysician Feedback Needed on Renewed Naturopath Scope EffortLatest_NewsShared_Content/News/Membership_Memo/2022/July_8/physician_feedback_needed_on_renewed_naturopath_scope_effort<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/july/mortar-pestle-645x425px.jpg" class="pull-right" alt="mortar and pestle" /></div> <h5>July 8, 2022</h5> <h2>Physician Feedback Needed on Renewed Naturopath Scope Effort </h2> <p>For the past several years, the Washington State Board of Naturopathy has made an effort to <a href="" target="_blank" rel="noreferrer">expand naturopaths' scope of practice to include nonsurgical cosmetic procedures through the rulemaking process</a>. If adopted, this change would allow naturopaths to administer botulinum toxin, dermal fillers, and other inert substances for cosmetic purposes. The education and training required to perform these procedures would be decided by the Board of Naturopathy, which comprises naturopaths and public members without experience in these procedures. While their progress on this rulemaking was stalled by other projects, the board has indicated it plans to refocus on the nonsurgical cosmetic procedure rulemaking.</p> <p>The WSMA has previously <a href="javascript://[Uploaded files/News and Publications/Newsletters/2022/board-of-naturopathy-non-surgical-cosmetic-procedure-comment.pdf]">shared our concerns</a> with this proposal. They include, but are not limited to, patient safety, lack of requisite education and training, and the fact that these procedures are inconsistent with the practice of naturopathy. We also hold that scope of practice expansions fall under the jurisdiction of the Legislature and are inappropriate for the rulemaking process.</p> <p>The Board of Naturopathy is still accepting public comment on this rulemaking. More than anyone else, the board needs to hear from physicians like yourself who have experience with these procedures. We encourage you to share your opposition to this proposal by emailing your comments to <a href=""></a> in advance of their Aug. 12 meeting. Should you have questions about the rulemaking process or how to best engage with the board, email WSMA Associate Director of Policy Billie Dickinson at <a href=""></a>.</p> </div>7/7/2022 12:00:00 AM1/1/0001 12:00:00 AM
covid_19_vaccines_approved_for_kids_6_months_to_5_yearsCOVID-19 Vaccines Approved for Kids 6 Months to 5 YearsLatest_NewsShared_Content/News/Membership_Memo/2022/June_24/covid_19_vaccines_approved_for_kids_6_months_to_5_years<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/june/boy-with-mask-645x425px.jpg" class="pull-right" alt="boy wearing mask" /></div> <h5>June 24, 2022</h5> <h2>COVID-19 Vaccines Approved for Kids 6 Months to 5 Years</h2> <p>Following approval by the U.S. Food and Drug Administration and the Centers for Disease Control and Prevention, the Western States Scientific Safety Review Workgroup on Sunday <a href="">concluded</a> that the Pfizer and Moderna COVID-19 vaccines are safe and effective for children as young as 6 months old, making the more than 380,000 children ages 6 months to 5 years in Washington eligible for vaccination. The authorization includes:</p> <ul> <li>A 3-dose Pfizer vaccine primary series for children ages 6 months - 4 years</li> <li>A 2-dose Moderna vaccine primary series for children ages 6 months - 5 years</li> </ul> <p>During the rise of the omicron variant in late December 2021, infants and children ages 0-4 in the U.S. were hospitalized at approximately five times the rate of the previous peak resulting from the delta variant. Vaccination has continually shown to be the strongest measure to prevent serious disease and death caused by COVID-19.</p> <p>While the Washington State Department of Health has indicated delays in initial supply from the federal government, they expect inventory to build over the coming days and weeks. Once you have the Pfizer and Moderna pediatric COVID-19 vaccines in stock, you may begin administering them to children ages 6 months and up.</p> <p>The following resources are now available for physicians and clinicians vaccinating this age group:</p> <ul> <li><a href="javascript://[Uploaded files/News and Publications/Newsletters/2022/baby-peds-june-16-update.pdf]">Washington State Department of Health COVID-19 Vaccination Plan for 6 months through 4 years</a> </li> <li>Moderna <a href="">fact sheet</a></li> <li>Pfizer <a href="">fact sheet</a> and <a href="">Dear Provider letter</a></li> </ul> <p> If your practice is providing the new pediatric vaccine and experiences operational or administrative barriers, please email <a href=""></a> so that we may inform the Department of Health and other relevant state agencies. </p> <p>If your clinic is not yet enrolled in the federal COVID-19 Vaccination Program (enrollment is required to administer COVID-19 vaccines), learn more and enroll on the <a href="">DOH website</a>, and join the <a href="">Power of Providers Initiative</a> to help educate and empower your patients to get vaccinated. If your practice does not offer the vaccine and patients are asking where they can locate the vaccine for their child, direct them to the state's <a href="">vaccine locator</a>.</p> <h3>WSMA-DOH COVID-19 Vaccines Webinar Series</h3> <p>If you haven't already, it's time to embed the COVID-19 vaccine into routine preventive care in your practice. The WSMA has joined the Washington State Department of Health to host a new webinar series to help physician practices and clinics access the tools and information they need to incorporate the COVID-19 vaccines into their practice workflows and employ effective strategies to engage patients in conversations about the vaccine. The first session, focused on embedding vaccines into preventative care, is scheduled for Friday, July 29 from noon-1 p.m. <a href="[@]WSMA/Education/Upcoming_Webinars/WSMA/education/Upcoming_Webinars/Upcoming_Webinars.aspx?hkey=b760d6bd-1833-412d-b681-babf251792a8">Register online</a>.</p> </div>6/23/2022 12:00:00 AM1/1/0001 12:00:00 AM
wsma_members_make_their_voices_heard_in_annual_advocacy_surveyWSMA Members Make Their Voices Heard in Annual Advocacy SurveyLatest_NewsShared_Content/News/Membership_Memo/2022/June_24/wsma_members_make_their_voices_heard_in_annual_advocacy_survey<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/may/spring-wa-capitol-645x425px.jpg" class="pull-right" alt="springtime at capitol" /></div> <h5>June 24, 2022</h5> <h2>WSMA Members Make Their Voices Heard in Annual Advocacy Survey </h2> <p>The WSMA recently asked for member feedback on advocacy priorities, and you responded. Well over 100 WSMA members from across the state and across specialties provided input on the issues most important to you and your practices. WSMA's advocacy team will use this information as we talk to political candidates and begin to compile our legislative agenda for the 2023 state legislative session.</p> <p>Respondents were first asked to rank priority items among 10 issues in the following three categories. The highest-ranking responses are listed below.</p> <ul> <li><strong>Practice of medicine</strong> <ol> <li>Addressing source of physician burnout, such as prior authorization.</li> <li>Defending against inappropriate scope of practice proposals.</li> <li>Ensuring access to abortion and a full array of reproductive health care.</li> </ol> </li> <li><strong>Public health and health equity </strong> <ol> <li>Continuing the state's response to the pandemic.</li> <li>Preventing firearm violence.</li> <li>(tied) Addressing homeless and housing as social determinants of health; and increasing health insurance options for undocumented residents of the state.</li> </ol> </li> <li><strong>Business of medicine</strong> <ol> <li>Advocating for Medicaid reimbursement rate increases.</li> <li>Limiting medical malpractice insurance rate increases.</li> <li>Facilitating utilization of value-based payment and alternative payment methodologies.</li> </ol> </li> </ul> <p>We also asked for respondents' priorities across the three categories and the top results were: physician burnout/prior authorization; abortion access; scope of practice; and Medicaid rate increases.</p> <p>Thank you to everyone who participated in the survey. If you have questions about the survey or would like to provide additional feedback about advocacy priorities, contact Sean Graham, WSMA's director of government affairs, at <a href=""></a>.</p> </div>6/23/2022 12:00:00 AM1/1/0001 12:00:00 AM
l-i_adopts_wsma-supported_emergency_rules_protecting_outdoor_workersL&I Adopts WSMA-Supported Emergency Rules Protecting Outdoor WorkersLatest_NewsShared_Content/News/Membership_Memo/2022/June_10/l-i_adopts_wsma-supported_emergency_rules_protecting_outdoor_workers<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img alt="" src="/images/Newsletters/MembershipMemo/2022/june/Outdoor-worker-645x425px.jpg" class="pull-right" /></div> <h5>June 10, 2022</h5> <h2>L&I Adopts WSMA-Supported Emergency Rules Protecting Outdoor Workers</h2> <p>The Department of Labor and Industries has adopted <a href="">emergency rules</a> that update requirements for occupational heat exposure hazards from high ambient temperatures. The rules are effective June 15 through Sept. 29, 2022 and require employers to provide shade sufficient to accommodate the number of employees on a rest or meal break. It also requires employees to take paid preventative cool-down rest periods of at least 10 minutes every two hours and clarifies that drinking water be suitably cool in temperature.</p> <p>The WSMA submitted an <a href="javascript://[Uploaded files/News and Publications/Newsletters/2022/WSMA-comment-emergency-rules-ambient-heat-outdoor-workers.pdf]">official comment</a> in favor of the emergency rules. Following last summer’s deadly heatwave, the WSMA House of Delegates voted in favor of policy advocating for access to heat protections for outdoor workers. The complete policy requires:</p> <p style="margin-left: 40px;"><em>That our WSMA advocate for outdoor workers to have access to preventative cool-down rest periods in shaded areas for prevention of heat exhaustion and health educational materials in their primary language. </em></p> <p style="margin-left: 40px;"><em>That our WSMA support legislation and regulations creating standardized protections against heat stress specific to the hazards of the workplace including appropriate access to emergency services when there are signs or symptoms of heat exposure injury.</em></p> <p>L&I will resume permanent rulemaking on this issue in the fall. If you have questions on this policy or rulemaking, please contact <a href=""></a>.</p> </div>6/10/2022 12:00:00 AM1/1/0001 12:00:00 AM
wsma_affirms_gun_violence_is_a_public_health_crisis_and_calls_for_actionWSMA Affirms Gun Violence is a Public Health Crisis and Calls for ActionLatest_NewsShared_Content/News/Press_Release/2022/wsma_affirms_gun_violence_is_a_public_health_crisis_and_calls_for_action<div class="col-md-12"> <div class="col-sm-5 pull-right"><img src="/images/Logos/Press-Release-Graphic-2019-Branding.png" class="pull-right" alt="WSMA press release logo" /></div> <h5>June 3, 2022</h5> <h2>WSMA Affirms Gun Violence is a Public Health Crisis and Calls for Action</h2> <p> SEATTLE (June 3, 2022) After a tragic week of lives lost to gun violence, the Washington State Medical Association again affirms that gun violence is a public health crisis affecting our children, communities, families, friends, and patients. We urge lawmakers to act. </p> <p> With the news of the shooting at St. Francis Medical Center in Tulsa-where former Seattle physician and WSMA member, Preston Phillips, MD, was among four individuals fatally targeted in yet another mass shooting-the WSMA calls on elected officials to move beyond rhetoric and take tangible action to solve this crisis. At the same time, the officers, board and members of the WSMA mourn the loss of our colleague and offer our sincerest condolences to Dr. Phillip's family, friends and colleagues as well as the loved ones of all victims of gun violence. </p> <p> The WSMA calls for state and national commonsense policies that would reduce injuries and deaths stemming from firearms. Our schools, hospitals, grocery stores and churches should be safe, rather than places where we fear for our lives. More must be done, immediately, to address this crisis, including passage of legislation on waiting periods, background checks and other policies, such as restrictions on assault weapons. </p> <p> The WSMA has longstanding policy in favor of legislation that "…would restrict the sale and private ownership of large clip, high-rate-of-fire automatic and semi-automatic firearms, or any weapon that is modified or redesigned to operate as a large clip, high-rate-of-fire automatic or semi-automatic weapon." </p> <p> After several years of the WSMA supporting legislation aligned with this policy, this year Washington's legislature passed SB 5078, which prohibits the manufacture and sale of large-capacity magazines as well as HB 1705, which prohibits untraceable "ghost guns." </p> <p> These are good advances in addressing the crisis, but more must be done, and quickly. </p> <p> The Washington State Medical Association and our member physicians are at the forefront of public health and patient care. Every day we treat the victims of gun violence. We are the ones whose hands probe the wounds, who seek to heal the bodies and who help mend the minds of those impacted by senseless gun tragedy. </p> <p> The WSMA will continue to actively advocate for and support policies aimed at encouraging firearm safety and preventing firearm-related injuries and death. We believe firearm injuries and death are preventable. Enough is enough. </p> <p> For more information, contact: </p> <p> Cindy Sharpe<br /> WSMA Communications<br /> 813.244.2883 (cell/text)<br /> <a href=""></a> </p> <h3>About the WSMA</h3> <p> The Washington State Medical Association represents more than 12,000 physicians, physician assistants, resident physicians, and medical students in Washington state. The WSMA has advocated on behalf of the house of medicine more than 125 years. Our vision is to make Washington state the best place to practice medicine and receive care. </p> </div>6/3/2022 12:00:00 AM1/1/0001 12:00:00 AM
introducing_wsmas_covid_19_vaccines_webinar_seriesIntroducing WSMA's COVID-19 Vaccines Webinar SeriesLatest_NewsShared_Content/News/Membership_Memo/2022/May_27/introducing_wsmas_covid_19_vaccines_webinar_series<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/may/covid-vax-vials-645x425px.jpg" class="pull-right" alt="COVID vaccine vials" /></div> <h5>May 27, 2022</h5> <h2>Introducing WSMA's COVID-19 Vaccines Webinar Series</h2> <p>Maintaining a patient population immunized against COVID-19is a large-scale challenge requiring a coordinated effort, one where primary care physicians play a crucial role-more so now that mass vaccine clinics are becoming a thing of the past. If you haven't already, it's time to embed the COVID-19 vaccine into routine preventive care in your practice. The WSMA has joined the Washington State Department of Health to help physician practices and clinics access the tools and information they need to incorporate the COVID-19 vaccines into their practice workflows and employ effective strategies to engage patients in conversations about the vaccine. </p> <h3>Part 1 - COVID-19 Vaccines: How to Embed them into Routine Preventive Care</h3> <p><em>Friday, July 29, from noon to 1 p.m. Free.</em></p> <p>The logistics of delivering COVID-19 vaccines in a practice or clinic setting may have been a barrier in the past for some organizations, particularly for smaller practices. Today, however, there have been many advances that have made administering the vaccine more convenient for practices of all sizes. Join us for this session where you'll learn how to:</p> <ul> <li>Bill for COVID-19 vaccine counseling and administration.</li> <li>Access small, more manageable quantities of COVID-19 vaccines from vaccine depots across the state.</li> <li>Join the more than 65,000 Washington physicians, PAs, and health care providers who have already committed to educating and empowering their patients to vaccinate.</li> <li>Leverage the physician toolkit and public-facing resources to help protect the health and well-being of your community.</li> </ul> <p>Guest speakers:</p> <ul> <li>Alison Hilkiah, provider outreach supervisor, COVID-19 Vaccine Initiatives, Washington State Department of Health</li> <li>Kim Huey, MJ, CHC, CPC, CCS-P, PCS, CPCO, COC, KGG Coding and Reimbursement Consulting, LLC</li> <li>Danielle Koenig, health promotion supervisor, Center for Public Affairs, Washington State Department of Health</li> <li>Mark Jowett Tan,owner, Bainbridge Island Community Pharmacy</li> </ul> <p><a href="">Register online for this free session</a>.</p> <h3>Part 2 - COVID-19 Vaccines: Strategies to Discuss the COVID-19 Vaccine with Your Most Reluctant Patients</h3> <p><em>Friday, Aug. 26, from noon to 1 p.m.</em></p> <p>Join an expert panel of physicians at this free webinar to learn effective strategies to engage patients in conversations about the COVID-19 vaccine by addressing their questions, fears, and concerns. Physicians from communities with low vaccination rates will provide real world examples of how to discuss the pediatric and adult vaccines, as well as booster vaccines. Representatives from the DOH will outline the key elements of its Power of Providers (POP) initiative and the resources included in the toolkit.</p> <p>Guest speakers:</p> <ul> <li>Shireesha Dhanireddy, MD, medical director, Infectious Disease Clinic, Harborview Medical Center</li> <li>Alison Hilkiah, provider outreach supervisor, COVID-19 Vaccine Initiatives, Washington State Department of Health</li> <li>Geoff Jones, MD, hospitalist and family medicine, Newport Health Center</li> <li>Gretchen LaSalle, MD,family medicine, MultiCare Rockwood Clinic - Quail Run</li> </ul> <p><a href="">Register online for this free session</a>.</p> </div>5/27/2022 12:00:00 AM1/1/0001 12:00:00 AM
oic_releases_annual_health_plan_prior_authorization_dataOIC Releases Annual Health Plan Prior Authorization DataLatest_NewsShared_Content/News/Membership_Memo/2022/May_27/oic_releases_annual_health_plan_prior_authorization_data<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/may/administrative-burden-645x425px.jpg" class="pull-right" alt="administrative burden illustration" /></div> <h5>May 27, 2022</h5> <h2>OIC Releases Annual Health Plan Prior Authorization Data </h2> <p>The Washington state Office of the Insurance Commissioner recently released its annual <a href="" target="_blank" rel="noreferrer">Health Plan Prior-Authorization Data report</a>, pursuant to WSMA's successful advocacy in passing Senate Bill 6404 during the 2020 legislative session. <a href="">SB 6404</a> requires carriers to report on prior authorization practices in several ways, including lists of prior authorization codes that received the highest number of requests, the highest percentage of approved requests, and the highest percentage of requests that were initially denied and subsequently approved upon appeal. Carriers are also required to report on average determination response times for prior authorization requests.</p> <p>Unnecessary use of prior authorization is a perennial concern for the WSMA as it drives administrative burden and costs for physicians and health care professionals, and delays or prevents necessary patient care. The OIC's 2021 report found that there were numerous codes that were approved 100% of the time. In fact, of the 469 distinct codes reported by carriers, 352, or 75% of the codes, were approved 100% of the time. Widely used codes for colonoscopies and psychotherapy were approved 99% of the time. All of which begs the question of what value prior authorization provides in those contexts.</p> <p>The report also showed that mental health and substance use disorder (MH-SUD) code requests faired poorer against medical surgical code requests (Med-Surg). Carriers reported a lower number of requests, approval rates, and response times for MH-SUD-related codes. Response times averaged around 174 hours for both inpatient and outpatient MH-SUD, compared to an average of 118 hours for inpatient and outpatient Med-Surg codes.</p> <p>The WSMA continues to review the OIC's report and is determining next steps as we work on compiling our 2023 legislative agenda. If you have any comments or concerns, please contact Sean Graham at <a href=""></a>.</p> </div>5/27/2022 12:00:00 AM1/1/0001 12:00:00 AM
presumptive_case_of_monkeypox_virus_in_king_countyPresumptive Case of Monkeypox Virus in King CountyLatest_NewsShared_Content/News/Membership_Memo/2022/May_27/presumptive_case_of_monkeypox_virus_in_king_county<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/may/monkeypox-645x425px.png" class="pull-right" alt="monkeypox virus under slide" /></div> <h5>May 27, 2022</h5> <h2>Presumptive Case of Monkeypox Virus in King County</h2> <p>Public Health - Seattle & King County and the Washington State Department of Health <a href="">are investigating a presumptive case of monkeypox virus infection</a> reported this week. With this first reported case in Washington, health officials are advising that, while the risk to the public is low, physicians, clinicians, and patients should familiarize themselves with the symptoms and risk factors of the viral illness.</p> <p>The U.S. Centers for Disease Control and Preventions has <a href="">updated information about monkeypox, including signs and symptoms and background on the current outbreak</a>. People who may have symptoms of monkeypox should contact their physician or health care provider. This includes anyone who:</p> <ul> <li>traveled to central or west African countries, parts of Europe where monkeypox cases have been reported, or other areas with confirmed cases of monkeypox during the month before their symptoms began,</li> <li>had contact with a person with confirmed or suspected monkeypox, or,</li> <li>is a man who regularly has close or intimate contact with other men, including through an online website, digital application ("app"), or at a bar or party.</li> </ul> <p>Based on recent cases, physicians and clinicians should consider a diagnosis of monkeypox in people who present with an otherwise unexplained rash and especially, but not exclusively, 1) traveled, in the last 30 days, to a country that has recently had confirmed or suspected cases of monkeypox 2) report contact with a person or people with confirmed or suspected monkeypox, or 3) is a man who reports sexual contact with more than one man in the past 30 days. Report suspected cases immediately to your public health district or department.</p> </div>5/27/2022 12:00:00 AM1/1/0001 12:00:00 AM
updated_guidance_for_use_of_paxlovid_covid_19_antiviralUpdated Guidance for Use of Paxlovid COVID-19 AntiviralLatest_NewsShared_Content/News/Membership_Memo/2022/May_27/updated_guidance_for_use_of_paxlovid_covid_19_antiviral<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/may/covid-spike-with-text-645x425px.jpg" class="pull-right" alt="COVID-19 spike with text" /></div> <h5>May 27, 2022</h5> <h2>Updated Guidance for Use of Paxlovid COVID-19 Antiviral</h2> <p>Physicians play a key role in helping to keep our patients out of the hospital and hospital capacity available for emergencies. With the COVID-19 virus still circulating in our communities, the physician community can do its part by ensuring COVID-19 therapies are available for their patients when clinically indicated. Reflecting revised guidance from the federal Food and Drug Administration, the Washington State Department of Health recently issued updated guidance for the use of Paxlovid, a key COVID-19 antiviral medication for use for the treatment of mild-to-moderate COVID-19 in adults and pediatric patients.</p> <p>Paxlovid consists of two medications, nirmatrelvir and ritonavir, which are copackaged for oral use. This medicine is authorized for people 12 or older and who weigh at least 40 kilograms. The course of treatment is only indicated for five days, and the prescription includes 30 tablets. Nirmatrelvir is a protease inhibitor of SARS-CoV-2, and ritonavir is used to boost levels of the drug. Paxlovid is currently available at select Safeway, Sav-On, and Haggen pharmacies, as well as numerous independent pharmacies across Washington. Physicians and practices can find locations using the <a href="">COVID-19 Therapeutics Locator</a>.</p> <p>For updated DOH recommendations to ensure equitable administration of Paxlovid, download <a href="" target="_blank" rel="noreferrer">Interim DOH Guidance for Use of Paxlovid</a> updated May 11, 2022. Visit the DOH website for more information on Paxlovid and other <a href="">COVID-19 treatments</a>.</p> </div>5/27/2022 12:00:00 AM1/1/0001 12:00:00 AM
the_house_of_medicine_celebrates_its_175th_birthdayThe House of Medicine Celebrates Its 175th BirthdayLatest_NewsShared_Content/News/Latest_News/2022/the_house_of_medicine_celebrates_its_175th_birthday<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/latest-news/2022/may/AMA-175-Anniversary-645x425px.jpg" class="pull-right" alt="AMA 175th Anniversary logo" /></div> <h5>May 23, 2022</h5> <h2>The House of Medicine Celebrates Its 175th Birthday</h2> <p> The gains we constantly make in diagnosing and treating illness and injury are easy to take for granted-until we realize just how far organized medicine has advanced since the mid-1800s, when bloodletting and blistering helped place "bodily humors" back into balance. </p> <p> Today, next-generation mRNA vaccines and groundbreaking advancements in gene therapy are just two examples demonstrating our tremendous progress in restoring health and maintaining wellness for all, which also means dismantling the structural and social drivers of health inequities. </p> <p> The American Medical Association, which marks the 175th anniversary of its founding this month, helps propel the science and research that drives organized medicine forward through advocacy and innovation built around the world's first-ever code of medical ethics. The AMA's work to both standardize and modernize medical education and physician training are key elements in meeting its mission to promote the art and science of medicine and the betterment of public health. </p> <p> As not only an individual membership association, but also the convening national body of medicine through its House of Delegates-comprising more than 190 state and specialty medical societies and other critical stakeholders-the AMA is the nation's largest and most influential medical organization. The policies adopted by the House of Delegates underpin its advocacy and guide ethical medical practice for millions of physicians in the U.S. and around the world. </p> <p> Delegates selected by the state medical associations, medical specialty societies, national medical organizations, and other recognized constituent associations that comprise the AMA House of Delegates meet twice each year to shape AMA policy and prioritize initiatives in medical education, ethical and judicial affairs, public health, diversity and inclusion, and a host of other subjects. </p> <p> Physicians who serve as delegates from the WSMA include: </p> <ul> <li>Amish Dave, MD</li> <li>Peter Dunbar, MD</li> <li>Matthew Grierson, MD</li> <li>Erin Harnish, MD</li> <li>Nariman Heshmati, MD</li> <li>Benjamin Meyer, MD</li> <li>Libby Parker, MD</li> <li>Elizabeth Peterson, MD</li> <li>Sheila Rege, MD</li> <li>Rodney Trytko, MD, MBA, MPH</li> </ul> <p> The WSMA has been proud to partner with the AMA on numerous initiatives and efforts over the years. A few recent examples: </p> <ul> <li>Through the Wellness Practice Transformation Initiative being led by the AMA and the Physicians Foundation, the WSMA Foundation, WSMA's non-profit organization dedicated to improving physician wellness and patient care, is identifying solutions and sharing best practices for improving the clinician experience and making meaningful change at the practice level.</li> <li>The WSMA frequently partners with the AMA when filing amicus curiae ("friend of the court") briefs that argue a physician-centric perspective in lawsuits of major importance to physicians, patients, and the practice of medicine. Most recently, this was demonstrated when the WSMA joined with the AMA and others to support a successful challenge to the independent dispute resolution rulemaking of the federal No Surprises Act.</li> <li>Working together on advocacy efforts at the federal level, lobbying Congress in support of Medicare sustainability (payment reform, telehealth), pandemic financial relief, and addressing the opioid epidemic. We have also collaborated to develop state-level solutions for issues like prior authorization, network adequacy, and scope of practice.</li> </ul> <p> Since the earliest days of its founding, the AMA and its state and specialty medical association partners have put patients first, from our earliest efforts to protect the public from medical quackery and fraudulent "medicines" that were ineffective at best and life-threatening at worst. Over the years, we have spoken for physicians in a unified voice in championing vaccine safety and efficacy, confirming the harmful effects of tobacco use while helping ban smoking on airliners, and advocating for seat belts as standard equipment in vehicles, among other initiatives. </p> <p> The AMA continues to fulfill its mission by working to remove obstacles to patient care, leading the charge to prevent chronic disease and confront public health crises, and driving the future of medicine through innovation and improved physician training and education. </p> <p> While the AMA can be rightfully proud of its contributions to organized medicine, the organization has also owned up to the fact that some of its prior actions and policies helped create many of the disparities and inequities in health that persist today. The AMA has acknowledged these mistakes and is working collaboratively to eliminate inequities throughout health care to achieve optimal health for all. </p> <p> As the AMA marks its 175th anniversary, its leadership is grateful for the contributions of time and volunteer service by millions of physician members who have advanced its mission over generations while working tirelessly to improve the health of their patients, communities, and our nation. </p> </div>5/23/2022 12:00:00 AM1/1/0001 12:00:00 AM
latest_health_care_cost_transparency_board_activity_provokes_concernsLatest Health Care Cost Transparency Board Activity Provokes ConcernsLatest_NewsShared_Content/News/Membership_Memo/2022/May_13/latest_health_care_cost_transparency_board_activity_provokes_concerns<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/may/stethoscope-numbers-645x425px.jpg" class="pull-right" alt="stethoscope" /></div> <h5>May 13, 2022</h5> <h2>Latest Health Care Cost Transparency Board Activity Provokes Concerns </h2> <p>The WSMA, in conjunction with the Washington State Hospital Association, submitted a third <a href="" target="_blank">comment letter</a> to the state's Health Care Cost Transparency Board in mid-April, outlining our continued shared concerns with inflation and the impact that COVID-19 has had and will continue to have on Washington's health care delivery system.</p> <p>In addition, we raised concerns with the decision-making process undertaken by the board, where decisions are often made before receiving feedback from the advisory committee. WSMA and WSHA recommended that the board more routinely seek advice and direction from the committee prior to making these critical decisions. Regarding the selection criteria, the letter strongly urges the board to consider not only the potential benefit in terms of reducing cost growth, but also whether a new strategy may cause harm to patients by reducing access to services or quality or have other unintended consequences.</p> <p>The WSMA continues to attend both board and committee meetings to monitor progress toward reducing cost growth spending in Washington's health care delivery system.</p> </div>5/13/2022 12:00:00 AM1/1/0001 12:00:00 AM
new_policies_in_effect_to_help_to_prevent_drug_overdoseNew Policies in Effect to Help to Prevent Drug OverdoseLatest_NewsShared_Content/News/Membership_Memo/2022/May_13/new_policies_in_effect_to_help_to_prevent_drug_overdose<div class="col-md-12"> <div class="col-sm-5 pull-right" style="text-align: center;"><img src="/images/Newsletters/MembershipMemo/2022/may/Buprenorphine-Butrans10mcg_645px.jpg" class="pull-right" alt="Buprenorphine" /></div> <h5>May 13, 2022</h5> <h2>New Policies in Effect to Help to Prevent Drug Overdose</h2> <p>Two new laws are now in effect that require health care service providers to offer patients medications for opioid use disorder and prevent physicians and providers from not accepting patients with a substance use disorder.</p> <ul> <li><a href="">RCW 71.24.585(2)</a> requires the Washington State Health Care Authority, as of Jan. 1, 2020, to "prioritize state resources for the provision of treatment and recovery support services to inpatient and outpatient treatment settings that allow patients to start or maintain their use of medications for opioid use disorder while engaging in services."</li> <li>A <a href="">U.S. Department of Justice memo</a> dated Tuesday, April 5, explains that the federal government considers substance use disorders as a disability under the Americans with Disabilities Act.</li> </ul> <p>Failure to allow medications for opioid use disorder in substance use disorder agencies can lead to a loss of Medicaid payments. Failure to allow the admission or treatment of people with opioid use disorder in any setting can lead to a federal complaint related to violating the ADA.</p> <p>These laws come at a time when overdoses, including those related to opioids, continue to increase. Last year, more than 100,000 people lost their lives to a drug overdose. Here in Washington, more than 2,000 people lost their lives. Increases in the use of methamphetamine and cocaine, the introduction of fentanyl into the state's illicit opioid supply, and the stress, strain, and anxiety of the last several years have all contributed to this rise.</p> <p>For more information on these policies, see this <a href="" target="_blank" rel="noreferrer">May 4, 2022 letter from Acting Medicaid Director Charissa Fotinos, MD, addressed to medical professionals and health advocates</a>. The Health Care Authority would be happy to partner with any agency looking to implement these policies. Contact Kodi Campbell at <a href=""></a> for more information.</p> </div>5/13/2022 12:00:00 AM1/1/0001 12:00:00 AM
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